NPIMap

Organization Active NPI

Evergreen Medical Center LLC

  • General Acute Care Hospital
  • Evergreen, AL
National Provider Identifier
1891770368
Registry record updated Sep 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
EVERGREEN MEDICAL CENTER LLC
Practice address
101 Crestview Ave
Evergreen, AL 36401-3333
Phone
(251) 578-2480
Fax
(251) 578-1055
NPI assigned
Dec 7, 2005
Last updated
Sep 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sharon Jones
Title
Chief Financial Officer
Phone
(251) 578-2480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

101 Crestview Ave
Evergreen, AL 36401-3333

Mailing address

PO Box 706
Evergreen, AL 36401-0706
Phone (251) 578-2480

Other identifiers 5

IdentifierTypeStateIssuer
529933017OtherALMEDICAID PHYSICIAN PAYEE
054OtherALBCBS
H0S0148HMedicaidAL
510G700322OtherMEDICARE PTAN
H565OtherMEDICARE PHYSICIAN PAYEE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20070510000538 AL Part A Provider - Hospital 6305942145 Practice locations: Evergreen, AL
O20080310000628 AL Part B Supplier - Clinic/Group Practice 6305942145 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: Evergreen, AL
O20080813000367 AL Part B Supplier - Clinic/Group Practice 6305942145 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
Practice locations: Evergreen, AL
O20111115000107 AL Part A Provider - Hospital 6305942145 Practice locations: Evergreen, AL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1891770368. Details of each certification follow.

Hospital certification: CCN 010148

Legal name
EVERGREEN MEDICAL CENTER LLC
Doing business as
EVERGREEN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 20, 1977
Last certification
Nov 2, 2023
Beds
44
Ownership / control type
Private (for profit)
Most recent change of ownership
Feb 1, 2007 (6 total)
Organization structure
LLCProprietary
Incorporated
Nov 14, 2006 in AL
Enrollment address
101 Crestview Ave
Evergreen, AL 36401-3333
Main/Primary Hospital Location
Hospital subgroups
Acute care, Swing-bed approved

Hospital certification: CCN 01U148

Legal name
EVERGREEN MEDICAL CENTER LLC
Doing business as
EVERGREEN MEDICAL CENTER SWING BED UNIT
Organization structure
LLCProprietary
Incorporated
Nov 14, 2006 in AL
Enrollment address
101 Crestview Ave
Evergreen, AL 36401-3333
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Evergreen Medical CenterCCN 010148 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0305030Evergreen Medical Center101 Crestview Ave, Evergreen, AL 36401ComplianceJan 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Medical Center LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kenneth Jeremy Craig Individual Corporate DirectorCfo May 1, 2020
Corporate OfficerCfo Apr 1, 2020
W-2 Managing EmployeeCfo Apr 20, 2020
Evergreen Medical Center LLC Organization, Evergreen, AL 5% Or Greater Direct Ownership Interest Feb 1, 2008
Thomas McLendon Individual Corporate OfficerCeo Jan 1, 2020
W-2 Managing EmployeeCeo Jan 1, 2020
Gilliard Health Services Organization, Evergreen, AL Corporation Operational/Managerial Control Apr 9, 2011
Elizabeth Ivey Individual Corporate OfficerCoo Nov 28, 2022
Operational/Managerial ControlCoo Nov 28, 2022
James M Scott Individual 5% Or Greater Direct Ownership Interest Feb 1, 2007

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evergreen Home CareEvergreen, AL, CCN 017106 Home health agency 5% Or Greater Direct Ownership Interest Feb 1, 2008
Evergreen Primary CareEvergreen, AL, CCN 013450 Rural health clinic 5% Or Greater Direct Ownership Interest Feb 1, 2008
Evergreen Medical Center LLCGeorgiana, AL, CCN 013499 Rural health clinic 5% Or Greater Direct Ownership Interest Feb 1, 2008

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

Affiliated clinicians 20

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220918400000",
    "number": "1891770368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 706",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "364010706",
            "telephone_number": "251-578-2480",
            "fax_number": "251-578-1055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CRESTVIEW AVE",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "364013333",
            "telephone_number": "251-578-2480",
            "fax_number": "251-578-1055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2008-09-09",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "251-578-2480",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PHYSICIAN PAYEE",
            "identifier": "529933017",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "054",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H0S0148H",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "510G700322",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PHYSICIAN PAYEE",
            "identifier": "H565",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen, AL

Sources for this page

Verify at the official NPI Registry.